Posted on
Saturday 11 January 2014

I find it almost impossible to hold what this article talks about in my mind. "Drug company sales representatives, using data these companies supply, can know before entering a doctor’s office if he or she favors their products or those of a competitor." The numbers are overwhelming:

Need another reminder of how much drugmakers spend to discover what doctors are prescribing? Look no further than new documents from the leading keeper of such data. IMS Health Holdings Inc. says it pulled in nearly $2 billion in the first nine months of 2013, much of it from sweeping up data from pharmacies and selling it to pharmaceutical and biotech companies. The firm’s revenues in 2012 reached $2.4 billion, about 60 percent of it from selling such information. The numbers became public because IMS, currently in private hands, recently filed to make a public stock offering. The company’s prospectus gives fresh insight into the huge dollars – and huge volumes of data – flowing through a little-watched industry.

IMS and its competitors are known as prescription drug information intermediaries. Drug company sales representatives, using data these companies supply, can know before entering a doctor’s office if he or she favors their products or those of a competitor. The industry is controversial, with some doctors and patient groups saying it threatens the privacy of private medical information. The data maintained by the industry is huge. IMS, based in Danbury, Conn., says its collection includes "over 85 percent of the world’s prescriptions by sales revenue," as well as comprehensive, anonymous medical records for 400 million patients. All of this adds up to 10 petabytes worth of material — or about 10 million gigabytes, a figure roughly equal to all of the websites and online books, movies, music and TV shows that have been stored by the nonprofit Internet Archive.

IMS Health says it processes and brings order to more than 45 billion health care transactions each year from more than 780,000 different feeds around the world. "All of the top 100 global pharmaceutical and biotechnology companies are clients" of its products, the firm’s prospectus says. Dr. Randall Stafford, a Stanford University professor who has used IMS data for his research, said the company has grown markedly in recent years through acquisitions of competitors and other companies that host and analyze data. As the pharmaceutical industry has consolidated, he says, IMS has evolved by offering more services and expanding in China and India. "They’ve been trying to beef up their competitiveness in some areas by making all of these acquisitions," he said.

IMS has especially expanded its database of anonymous patient records, which can match patients’ diagnoses with their prescriptions and track changes over time, Stafford said. IMS sells two types of products: information offerings and technology services. The information products allow pharmaceutical companies to get national snapshots of prescribing trends in more than 70 countries and data about individual prescribers in 50 countries. IMS’s prospectus offers examples of the questions companies are able to answer with its data, including which providers generate the highest return on a sales rep’s visit, whether a rep drives appropriate prescribing and how much reps should be paid…

I didn’t prescribe much and never saw drug reps, so this is a part of the world I sidestepped. But it immediately brings up a point I haven’t heard anyone mentioning. Apparently, a pharmaceutical company can find out exactly what I prescribe, and can come by anonymized patients records for their marketing research just by paying IMS’ asking price. But they stand in front of us and act like our requests for the raw data from their clinical trials and for the subjects’ anonymized clinical records is an affront to patient privacy and their commercial secrets. It’s hard for me to imagine that the pharmaceutical sales rep is privy to the data about my prescribing, and about my patients, but I’m unable see the data on the drug he’s/she’s trying to get me to prescribe, except as it’s carefully abbreviated and dolled up for publication by his company’s medical writing team. It’s okay for marketing research, but not medical research? That is totally crazy… totally crazy…

The legality of these practices were tested all the way to the Supreme Court, after the State of Vermont tried to outlaw it. The US Supreme Court ruled favorably for the industry by a 6-3 vote in 2011. The argument boiled down to a First Amendment free speech issue.

According to one account, “Speech in aid of pharmaceutical marketing…is a form of expression protected by the Free Speech Clause of the First Amendment. As a consequence, Vermont’s statute must be subjected to heightened judicial scrutiny. The law cannot satisfy that standard,” Justice Anthony Kennedy wrote for the majority.

Despicable is the better term for me. Oh, and check out the opinion piece by Edward Teach at http://www.psychiatrictimes.com re the farce that really is the Maintenance of Certification exam. It is just pathetic how so much is done for just superficial show and profit. If I hit lotto for big money, sorry to patients who need advocates, but I would be done clinical care.

I’d still be writing harsh commentary about the assorted losers who rule psychiatry and health care in general. But, words seem fairly useless.

Shame and humility, pride and ownership, concepts gone , buried, and forgotten among most in medicine.

Just to be clear, when I commented on the legal status of this industry I was not endorsing its ethics. There is a discussion of the difference over on Health Care Renewal here.

Does anyone know whether the professional pharmacy organizations approve the sale of prescription data linked to individuals? For all that pharmacists talk nowadays about being part of the clinical team, you would think they would shun that practice as incompatible with a clinician’s code of ethics. Money talks, I guess.

I don’t normally put much trust into this source, but this one is information about a Congressional hearing.

““The data broker industry as it is today, does not have constraints and it does not have shame,” she explained. “It will sell any information about any person regardless of sensitivity for 7.9 cents a name, which is the price of a list of rape sufferers which was recently sold.”

“Lists of rape sufferers, victims of domestic violence, police officers’ home addresses, people who suffer from genetic illnesses,” Dixon continued. “Complete with names, home addresses, ethnicity, gender and many other factors. This is what’s being sold and circulated today.”

According to Dixon, the industry was now using “pseudo-scores” for credit decisions that were based on non-financial factors, allowing companies to circumvent the Fair Credit Reporting Act.”

In the mid 1990’s, I was the medical director of a community mental health center. I would chat with the drug reps and they supplied the clinic with samples for our patients without insurance (roughly 40% of the patients). One day, one of the drug reps confronted me with the fact that I wasn’t prescribing the medicine he pushed! I was shocked then that he had access to my prescribing habits, but this is not new, it’s been going on for decades, even before the computerization of prescribing.

Per Bernard Carroll’s second comment here, I would bet the decision to release info is controlled by the pharmacy owner, ie a CVS/WalMart/Walgreens etc, and not decided by the pharmacist. I would bet most pharmacists would actually say “sorry, not willing to participate”, but, some would if the kick back is in their wallets as much as the business’.

Oh, and having a similar experience with a rep as Dinah notes above, my terse rebuttal was easy and quick: “yeah, ’cause I don’t like it, and at least I am consistent, no faith in a product means don’t write for it!’

Never had a Lilly Rep call on me again for Zyprexa. Wish I had thought of that about 3 or so years earlier!!! Oh, and this was a rep who argued with me that Zyprexa was not responsible for weight gain. Incredible what reps will say, just to make a sale!!!

I am surprised at the surprise. In the mid-1970’s I was made aware that drug reps knew what a doctor was prescribing. This was tied to the physical location of a practice and the demographics of the surrounding community. A practice in a low income area with a bus stop out front would be treated differently than a suburban practice in an upper income area.

We need to also remember that pharma often knows of the negative effects of its drugs, but for business reasons, will continue to market them as seen in this link:

There is also the myth that drug companies give drugs to low income practices. The simple reality is drug companies know these patients will not be able to buy the prescriptions, so they do not service these practices.

It would be easy to say all drug companies are bad, but this would discredit all of those who are working at the bench on cures.

It would be easy to blame the salespeople, but they have been groomed from the start of their jobs to follow the marketing pitch given them by the marketing department.

The real culprit is a corporate culture that places winning at any cost, with as few deaths as possible to limit liability, as the sole goal.

To Dr. Hassman’s point: if the corporate owners of these pharmacy chains are the ones selling patients’ information then there clearly is a professional and ethical boundary issue here. Are the clients informed of the practice? Are they able to opt out?

Imagine how similar boundary violations might play out when we progress to corporate medicine!

Actually, this process of only including self-flattering data and dismissing that that contradicts is a perfectly normal process of authoritarian and fundamentalist thinking. Considering the closed nature of prejudice, a lack of critical thinking, and an inability to challenge the shibboleths of the day for purposes of identity, status, and wealth; corruption is inevitable because reality has a way of saying otherwise. How can the “it” of psychiatry and neuro-psychiatry stay comfortably nested in the delusion of biological determinism, it’s discontents, and its solutions without fudging the data? How can they retain their authoritative prerogative of deciding what is and is not mentally ill and what to do about it without disregarding the lion’s share of human history, human understanding for persons as well as all of humanity?
They simply do not have a coherent foundation to work from. The “it” of psychiatry is a self-aggrandizing and conformist white man with delusions of having a scientific mind. Lies, damn lies, and statistics— it’s so hard for them to stand atop all of humanity and say, “THIS is what your problem is. And THIS is what should be done about it.,” with no grounding in the humanities nor hard science, and what appears to be a distaste for humility, and complexity.
It is smug beyond all reasonable belief.
We need this like we need fascism or any other totalitarian system of beliefs and values that exists to uphold overweening indulgence in one’s own perspective and values, and a distaste for what doesn’t conform to a pet postulate that involves near worship from stupid disciples, deference from other authorities, and the indulgence of wealth.

This selling of prescribing data — stripped of patient names, but not prescribers’ — isn’t new, nor is its use by drug reps. Mickey was making a better point about the asymmetry in our “transparent” prescribing records, versus the lack of transparency in research data. I would add that sophisticated data mining now allows savvy marketers and other entities to combine data to de-anonymize many such databases. Lack of privacy in both private and professional life has become the new norm.

Indeed, that was a major theme in the recent book Big Data that Mickey wrote about. The question is, do we want this to be the new norm? Don’t pharmacists have a professional code of ethics? Were they to come together and say this practice invalidates their claims to be members of the clinical team then a bottom feeder corporation like IMS would soon be out of business.